<h1>
    Demande de renseignement</h1>
<table width="100%" border="0">
  <tr>
    <td width="80%"><form action="cible.php" method="post">
      <div>
        <fieldset>
        <legend>Vos coordonn&eacute;es</legend>
          <div>&nbsp;</div>
          <label for="raison">Raison sociale:</label>
        <input type="text" name="raison" size="20" maxlength="40" value="" id="raison" />
        <p>
          <label for="nom">Nom:</label>
          <input type="text" name="nom" size="20" maxlength="40" value="" id="nom" />
        </p>
          <p>
          <label for="label">Pr&eacute;nom :</label>
          <input type="text" name="prenom" size="20" maxlength="40" value="" id="label" />
        </p>
          <p>
          <label for="label2">Fonction :</label>
          <input type="text" name="fonction" size="20" maxlength="40" value="" id="label2" />
        </p>
          <p>
          <label for="label3">Effectif:</label>
          <input type="text" name="effectif" size="20" maxlength="40" value="" id="label3" />
        </p>
          <p>
          <label for="label4">Adresse :</label>
          <input type="text" name="adresse" size="20" maxlength="40" value="" id="label4" />
        </p>
          <p>
          <label for="label5">Code postal:</label>
          <input type="text" name="cp" size="20" maxlength="40" value="" id="label5" />
        </p>
          <p>
          <label for="label6">T&eacute;l&eacute;phone :</label>
          <input type="text" name="tel" size="20" maxlength="40" value="" id="label6" />
        </p>
          <p>
          <label for="label7">E-mail :</label>
          <input type="text" name="label" size="20" maxlength="40" value="" id="label7" />
        </p>
          <p>&nbsp; </p>
          <p>
          <input type="submit" value="Envoyer" />
          </p>
          </fieldset>
      </div>
      <p>&nbsp;</p>
    </form></td>
    <td width="20%"><img src="images/cle.jpg" /></td>
  </tr>
</table>
<p>&nbsp;</p>
